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A TRUE COPY <br /> CERTIFICATION ON LAST PAGE <br /> J . K . BARTON , CLERK <br /> C. Special Amenities (Optional) <br /> This Section is for optional use of the HA . It is designed to collect additional information about other positive features of the unit that maybe present. <br />Although <br /> the features listed below are not included in the Housing Quality Standards , the tenant and HA may wish to take them into consideration in decisions <br /> about <br /> renting the unit and the reasonableness of the rent. <br /> Checklist any positive features found in relation to the unit. <br /> 1 . Living Room 4 . Bath <br /> High quality floors or wall coverings Special feature shower head <br /> Working fireplace or stove Built-in heat lamp <br /> Balcony, patio , deck, porch ❑ Large mirrors <br /> Special windows or doors Glass door on shower/tub <br /> Exceptional size relative to needs of family Separate dressing room <br /> Other: (Specify) ❑ Double sink or special lavatory <br /> Exceptional size relative to needs of family <br /> ❑ Other: (Specify) <br /> 2. Kitchen <br /> Dishwasher <br /> Separate freezer <br /> Garbage disposal <br /> ❑ Eating counter/breakfast nook <br /> Pantry or abundant shelving or cabinets <br /> S . Overall Characteristics <br /> Double oven/self cleaning oven , microwave <br /> [—]Double sink Storm windows and doors <br /> High quality cabinets ❑ Otherforrnsofweatherization (e.g . , insulation , weather stripping) <br /> D Abundant counter-top space Screen doors or windows <br /> Modern appliance (s) ❑ Good upkeep of grounds (i . e. , site cleanliness, landscaping , <br /> Exceptional size relative to needs of family condition of lawn ) <br /> Other: ( Specify) 7 Garage or parking facilities <br /> Driveway <br /> Large yard <br /> Good maintenance of building exterior <br /> Other: ( Specify) <br /> 3 . Other Rooms Used for Living <br /> High quality floors or wall coverings <br /> Working fireplace or stove <br /> Balcony, patio , deck, porch <br /> 6 . Disabled Accessibility <br /> Special windows or doors <br /> Unit is accessible to a particular disability. , . . . Yes No <br /> ❑ Exceptional size relative to needs of family u <br /> Other: (Specify) Disability <br /> D . Questions to ask the Tenant (Optional ) <br /> 1 . Does the owner make repairs when asked ? Yes j] No <br /> 2 . How many people live there ? <br /> 3 . How much money do you pay to the owner/agent for rent? $ <br /> 4 . Do you pay for anything else ? (specify) <br /> 5 . Who owns the range and refrigerator? (insert O = Owner or T = Tenant) Range Refrigerator . Microwave <br /> 6 . Is there anything else you want to tell us? (specify) Yes No iw N <br /> Previous editions are obsolete Page 6 of 7 form HUD-52580 (3/2001 ) <br /> ref Handbook 7420 . 8 <br />